I have a patient story I feel like I need to talk out. For some background, I'm an IM resident and I plan to do a fellowship in palliative care. My undergraduate degree was in anthropology, so I feel like I have a good background in cultural competency and recognizing ethnocentrism. I've been peripherally involved in the care of this patient.
I'll try to keep it to minimal identifying details. The story goes, little old lady comes in to the hospital (for what is at this point irrelevant). She's bedbound, now minimally interactive, on dialysis. Lots of discomfort/pain with repositioning and care, pretty much always looks uncomfortable at baseline. I've seen plenty of folks like this, and they're a big part of my motivation for going into palliative care. Where the story gets tricky is her family situation and GOC. Of course she's had plenty of family meetings about her situation – the family wants to continue her dialysis even though it causes her discomfort (occasionally to the point of needing restraints). As I understand it, they believe that her suffering is helping with her sin, so in that sense, it is a good thing.
I'm floored by this. I see where the cultural conflicts lie and I can see why they feel this way, but her situation is sticking in my gut. I've run up against an ethnocentric line that runs parallel with my training and my motivation as a physician. Luckily this is not my patient so I don't have responsibility or a direct stake in what's going to happen to her. But, I'm planning on a career in palliative care. I am going to run into families like hers. I feel like I'm pretty good at cultural competency, but this is just beyond me. How have y'all dealt with this kind of situation?
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